Anjali Pahad*,
Nidita Karkare**, Avani Pathak ***
Abstract
The need for bringing
down maternal mortality rate significantly and improving maternal health in
general has been strongly stressed in the national population policy 2000. To
reduce home deliveries and maternal child mortality rate, the government of
India took steps to strengthen maternal and child health services. Many
attempts have been made to understand the mechanism of maternal mortality in
India and antenatal care; institutional delivery have been identified as
important contributors for reducing maternal mortality rate (MMR). Thus, with
the promotion of institutional delivery the maternal mortality rate can be
decreased Keeping in mind the importance of women’s health for family and
nation , an action project was planned with an objective to create awareness on
importance of institutional delivery amongst the community volunteers and
pregnant women of three selected villages of Sinortaluka. Project conducted in
different phases. First preliminary survey was done to find out
the general awareness level of the villagers. Based on survey planning and
execution of the project was done. Reaction tool was filled up for knowing
their reactions regarding the awareness generation programme for evaluation
purpose. After the completion of the extensive awareness generation programme
in all three villages selected, it was found that hundred percent institutional
deliveries were conducted in two villages however in Barkal village after many
attempts hospital deliveries were conducted. Awareness
was generated on different topics like importance of institutional delivery,
importance of medical treatment, etc. Villagers were convinced for the
promotion of institutional delivery practices. The pregnant women had the three
antenatal visits needed during pregnancy period. They were more conscious about
the nutritious food. Majority of the pregnant women started availing facilities
provided by the government in the villages.
Introduction
The maternal and child health
plays a very significant role on the quality of life of each generation.
Mother’s health also influences the health of the next generation. So one may
say that the health of the nation is dependent on the health of women and
children. Mukhopadhyayand Sarkar (2009),
in an article titled “Pregnancy-related food habits among women of rural
Sikkim, India”: expressed that, for each person food is a vital component of
life, as it contains the nutrients. He/she needs for daily living and also
plays an important role in social life. However, food in appropriate quantities
is not always accessible to all people, due to various political, economic and
geographic reasons. Mothers in developing countries, especially pregnant and
lactating ones, are considered to be nutritionally vulnerable as they are often
subjected to different degrees of nutritional stress. It has been established
that women from less privileged communities in India tend to suffer from
malnutrition of different grades and their dietary energy intake is not always
adequate to compensate for the heavy physical workload which they often have to
undertake. The success of lactation and the health status of the infant depend
entirely on the type of diet consumed by women during pregnancy and lactation
.It is widely accepted that cultural beliefs and practices play a role in the
successful dissemination of nutrition messages to the community.
What is Maternal Mortality?
According to Dutta, (2004),
“maternal deaths means death of woman while pregnancy and within 42 days of the
termination of pregnancy irrespective of duration and site of the pregnancy
from any cause related to or aggravated by the pregnancy or its management but
not from accidental or incidental causes”.
Maternal Mortality Ratio
According to Dutta, (2004), “the
Maternal mortality rate is expressed in terms of maternal deaths per 1, 00,000
live births.” It means the women who die in a year due to causes related to
pregnancy and child birth for every 1, 00,000 live births.The need for bringing
down maternal mortality rate significantly and improving maternal health in
general has been strongly stressed in the national population policy 2000. This
policy recommends a holistic strategy for bringing about total intersectoral
co-ordination at the grass root level and involving the non government
organizations, civil societies, panchayati raj institutions and women’s group
in bringing down maternal mortality rate.
The Need and Importance of Institutional Delivery
According to Mathu and Pandya
,(2006), “Comprehensive minimal care during pregnancy,
child birth and there after steps to ameliorate malnutrition as well as
decrease the work load of women and improve access to health services should be
the silent instruments for improving the health of women.The guiding principle
for the first time and a half decade of planned development in health in India
included measures to:make health services more accessible to the women ,
developing the needed human resources , provision of services for health
including maternal and child health” So many attempts have always been made to
understand the mechanism of maternal mortality in India and antenatal care;
institutional delivery have been identified as important contributors for
reducing maternal mortality rate (MMR). Therefore, national rural health
mission has an important goal and carries many efforts in this direction. The
efforts and steps taken towards the institutional delivery have played a very
effective role in reducing maternal mortality rate (MMR).National family
healthy survey was conducted in the year 2005-06, in various states of India.
The finding of the survey highlighted the maternal mortality rate (MMR) and
institutional delivery of the selected states. It revealed that the rate of
maternal mortality decreased with increasing rate of institutional delivery.
Table shows that the maternal mortality rate was high in Uttar Pradesh state
where as institutional delivery rate was only 19 percent. Where as compared to Gujarat
the institutional delivery rate was high i.e.55 percent and the maternal
mortality rate was 172 which was relatively less.Thus, with the promotion of
institutional delivery the maternal mortality rate can be decreased. Keeping in mind the importance of women’s
health for family and nation an action project was planned with an objective to
create awareness on importance of institutional delivery amongst the community
volunteers and pregnant women of three selected villages of Sinortaluka.
Objectives of the project
·
To
create awareness on importance of institutional delivery to selected community volunteers of
MotaFofaliya,Zanzad and Barkal, villages of Sinortaluka, Vadodara.
·
To
evaluate the community volunteers on their skills for creating the awareness on
importance of institutional delivery to selected pregnant women of
MotaFofaliya, Zanzad and Barakal, villages of Sinortaluka, Vadodara.
·
To
study the reactions and suggestions of the selected community volunteers
regarding the awareness generation programme on importance of institutional
delivery conducted by the project worker.
·
To
study the reactions and suggestions of the selected pregnant women regarding
the awareness generation programme on importance of institutional delivery
conducted by community volunteers.
Justification of the Project
According to Das,(2007) “in India’60-70
percent of the population thrives in rural area, rural women acquires an
important role in rural development. They are capable of improving the quality
of life in rural communities by remaining fit and healthy.Women can play a
significant role in contributing social, economic, cultural, educational and
political development in a country. In a family, women are the only one who
takes care of everyone .She deals with home related things as well as stays in
touch with other members of the family and children .She is like a pivot in the
family through which development can be attained. It is because when women get
all the development it is spontaneously passed on to the other members in the
family. But, for the attainment of development she should be aware about
various information around her, to satisfy her needs. So, this project is
mainly for creating and strengthening awareness about “institutional delivery”
amongst community volunteers and pregnant women.”Home deliveries are very
commonly prevalent practices in many villages of Gujarat. This leads to many
problems like,
·
Pregnant women get scared of
taking injections.
·
Sometimes they are unaware
about their delivery date.
·
Many women think that
hospital delivery is an expensive affair and so they prefer home delivery.
·
Sometimes they are not aware
about the government’s schemes, which can finally help them for delivery in
hospitals.
In the villages selected for this project,
majority of women are laborers. They have to work hard during pregnancy period
also and they can not take rest which is needed during pregnancy period. This
is very harmful for the mother and her baby also. Hence the need was felt by
the project worker to create awareness amongst them on importance of
institutional delivery.
The success of the project may motivate
pregnant women of these villages for promoting institutional delivery that will
yield tangible results.
Thus institutional delivery project was
planned in MotaFofaliya, Zanzad and Barkal villages. If this project sustain
for longer period of time then it may provide multidimensional benefits like
increase in institutional delivery, good care of pregnant women, deliveries of
healthy baby, etc.
METHODOLOGY
The
project was divided into four phases
|
No
|
Phase-1
(Preliminary survey)
|
Phase-2
(Planning of the project)
|
Phase-3
(implementation of the project)
|
Phase-4 (Evaluation of the awareness
geneartionprogramme on institutional delivery)
|
|
1
|
Visits to the selected villages for project
|
Selection of the content on creating
awareeness on importnce of instituional deliveries
|
(Part-A)-Implementation
of the project for the commuinity volunteers by the project worker.
|
The reactions of
the community volunteers regarding awareness generation programme on
institutional delivery
|
|
2
|
Interview with anganwadi workers, asha
workers and dais
|
Preparation of the teaching learning
material
|
Rapport building with the community
volunteers
|
The reactions of
the pregnant women regarding awareness generation programme on institutional
delivery
|
|
3
|
Home visits of pregnant women.
|
Preparation of reaction tool for evaluation
|
Execution of the project by the project
worker for the community volunteeers
|
|
|
4
|
Findings of the survey
|
|
(Part-B) Implementation of the project for
the pregnant women by the commuinty volunteers.
|
|
PHASE-1-Preliminery Survey
Project worker conducted a
preliminary survey in three selected villages i.e. MotaFofaliya, Zanzad and
Barkal to know the awareness level of the community volunteers regarding the
importance of institutional delivery.
To conduct the preliminary survey following
steps were carried out by the project worker Finding of the Survey
The project worker received
the data regarding the institutional and home deliveries from the community
volunteers which reveled that is the in Barkal village seventy percent 70
percent of the women, in Zanzad village 40 percent of the women and in the
MotaFofaliya village 20 percent of the women had delivered their babies at
home. Majority of the deliveries of the
pregnant women were done at home with the help of untrained dais.
Majority of the community
volunteers had not taken the training related to the awareness generation of
institutional delivery programme. They did not have any teaching learning
material for convincing the people for institutional delivery, too. So the
anganawadi workers, asha workers and dais had confidence on project worker that
she would be able to promote the awareness of institutional delivery of their
village. This awareness programme would
definitely solve their problems of unsafe home deliveries, which are harmful
for baby and mother both. So after the survey the project worker had finally concluded
that there is a great need to create awareness on importance of institutional
delivery, the importance of mother’s health, food, nutrition etc to minimize
the number of home delivery and to motivate the people, institutional for
institutional delivery.
PHASE-2 Planning of the Project
Selection
of the Content on Creating Awareness on Importance of Institutional Delivery
Project worker prepared
content on creating awareness on importance of institutional delivery. For
these she had visited different non government organizations and resource
persons working in the area of the health, particularly for women. The content
was adapted from different sources like books, non government organization’s
material, web sites and non government organization’s manual. Once the content
was finalized, it was validated by the experts.
Preparation
of Reaction Tool for Evaluation
There were two reaction tools
prepared by the project worker, one was for the community volunteers and the
other on was for the pregnant women.
PHASE 3: Implementation of the Project
This third phase of the
action project was the actual implementation of the activities for imparting
awareness on importance of institutional delivery. The third phase was divided
in two parts. The first part of this phase was implementation of the activities
for the community volunteers by the project worker and the second part was
implementation of the activities for the pregnant women by the community
volunteers.
PART-A,
Implementation of the Activities for the Community Volunteer by the Project
Worker
1)
Rapport building with community volunteers
Project worker met all the
anganawai workers, asha workers and dais. All of them were very helpful and
enthusiastic. First, the project worker had discussed about the subject on
which she is going to take action with the help of anganwadi workers, asha
workers and dais. As the topic was familiar with them, so they were taking
interest in the project. They were very eagerly waiting of the project’s
initiation. There were eighteen community volunteers of which seven were asha
workers, seven anganawadi workers and four were dais of MotaFofaliya, Zanzad
and Barkal villages.
2)
Execution of the projectby the project worker for community volunteers
Project worker had selected
three different villages MotaFofaliya, Zanzad and Barkal. All the community
volunteers could not get together at the same place so project worker had
arranged awareness programmes at their own villages at different times. Thus
the project worker executed the awareness generation programme on importance of
institutional delivery separately in all three villages through different
materials and methods for implementation of the project like charts, posters,
calendar, documentary movie, flip books etc.
Details of the activities conducted under the project are
mentioned below:
1)
Illustrated talk: The project
worker had given illustrated talk on different topics like internal organs of
the women, development period of baby during pregnancy period, importance of
institutional delivery. For this project worker had used discussion and
lectures as a method. She had used teaching learning materials like charts,
posters, flip books, calendar.
2) Expert
talk: The project worker had invited
Dr.Salim Shekh from Shree C.A.Patel Hospital, MotaFofaliya as a expert. He had
given talk on the importance of institutional delivery and various government
schemes for the pregnant women. He had explained the importance of
institutional delivery and harmful effects of the home delivery.
3) Bhavai
on institutional delivery: Thebhvai on
institutional delivery was performed by the project worker and other supporters
.The main aim of the bhavai was imparting awareness to stop home delivery and
get the benefit of the institutional delivery along with the entertainment.
4)
Documentary movie on importance of institutional delivery: The documentary movie on the importance of institutional
delivery was show by the project worker. The name of the documentary movie was
“kali kemmari?” project worker had collected the CD of “kali kemmari?’ by
Shroff foundation a non governmentorganization.This movie was mainly on the
harmful effects of home deliveries. It focused on the babies delivered by the
dais at home which have harmful effect on the health of the mother and baby.
PART-B,
Implementation of the Activities for the Pregnant Women by the Community
Volunteers
1)
Rapport building with the pregnant women
Project worker had another target group which was of pregnant women.
So she had build rapport with the pregnant women through home visits. She had
discussed with them about the project and activities. Initially they got scared
and felt shy with the project worker but after rapport building they were much
closer to the project worker. There were 20 pregnant women from three selected
villages.
2)
Execution of the project by the community volunteers for the pregnant
women
The second part of the
project was awareness programme for pregnant women by community volunteers. So
in this part the awareness on importance of institutional delivery was
generated by the community volunteers amongst the pregnant women through
different materials and methods for implementation of the project like charts,
posters, calendar, documentary movie, flip books etc.
Details of the activities conducted under the project are
mentioned below:
Illustrated talk: Community volunteers had created awareness on importance
institutional delivery. They had covered different topics which were internal
organs of the women, development period of baby during pregnancy period,
importance of institutional delivery. Community volunteers had used discussion
and lecture methods.
Expert talk: The community volunteers also approached Dr. Salim Shekh
was selected for expert talk who was doctor of the Shree C.A.Patel Hospital,
MotaFofaliya. He had emphasized his talk on the importance of institutional
delivery and government schemes for the pregnant women. He had explained very
carefully and with easy to understand language.
Documentary
movie on importance of institutional delivery : A movie was shown by the community volunteers to the pregnant women,
too. It was mainly on the harmful effects of home deliveries.
Evaluation of the Awareness Generation Programme
The
Reactions of the Pregnant Women Regarding Awareness Generation Programme on
Institutional Delivery
As the programme was divided
in two parts, thus there was a need of seeking reactions of the programme
conducted by the community volunteers for the pregnant women. So another
reaction tool was filled up by the pregnant women for knowing their reactions
regarding the awareness generation programme, the community volunteers and
methods and materials used in awareness generation programme.
Evaluation
by the Project Worker of the Selected Community Volunteers.
1) The community volunteers
had shown their interest during whole project. They eagerly participated and
conducted the programme of the importance of institutional delivery.
2) They enthusiastically
conducted programme for the pregnant women
3) Earlier no one had
provided any teaching learning material to them for creating awareness. At
Initial stage they were having some difficulties in handling teaching learning
material during explanation. But later on they were able to use teaching
learning materials effectively.
4) Community volunteers were
from the same community as of the villagers so they could easily convince the
target group (pregnant women) for promoting institutional delivery.
5) Community volunteers were
already engaged in the same work. But they had fear at some places as they
didn’t have enough knowledge. After getting the right information they
confidently took the sessions
Outcomes of the Project
Last year i.e. before the
commencement of this present project majority 70 percent of the pregnant women
had conducted home delivery where as only thirty percent pregnant women
registered with the hospital in the Barkalvillage.In the Zanzad village
majority 40 percent of the pregnant women delivered their babies at the home
where as only thirty six percent had delivered their baby in the hospital.In
the MotaFofaliya village all the community volunteers wanted that all the
pregnant women must deliver their babies in the hospital but because of some
problems like superstitions, the awareness of their expected delivery date etc,
were not able to get hundred percent results.Majority of the pregnant women had
checked up their weight, urine test, blood test and blood pressure. Majority of
the pregnant women had taken three necessary antenatal visits, vaccinated and
received all the iron’s tablets after the awareness generation programme on
institutional delivery.After the completion of the extensive awareness
generation programme in all three villages, project worker had found out that
hundred percent results in MotaFofaliya and Zanzad village however in Barkal
village she did not get hundred percent result. She found that fifty percent of
the pregnant women had conducted their delivery in the hospital. So it was
found that twenty percent result was increased after the awareness generation
programme.Villagers of Barkal didn’t want to change their delivery practice as
they very highly suppositious. After the awareness generation programme some
were convinced and had conducted hospital deliveries.
To conclude the Project worker had created
awareness on different topics like female organs, importance of institutional
delivery, importance of medical treatment, etc. Project worker was able to
convince the villagers for the promotion of institutional delivery practices. They
also agreed to deliver their babies in the hospital. The pregnant women had the
three antenatal visits needed during pregnancy period. They were more conscious
about the nutritious food. Majority of the pregnant women started availing
facilities provided by the government in the villages.
REFERENES :
Dutta. D. C (2004), Textbook
of Obstetrics, 6th edition, new central book agency Pvt. Ltd.
Kolkatta.
Mathu.A and
Pandya.R,(2006),Facets of women’s development, Kalpaz publication, Delhi.
Nithianandam.S(February,2009),Social
Welfare,Vol No.55 Institutional delivery and relationship with infant
mortaloity rate.
Gaur.P(2009),Social
welfare,Vol.55.delivery practices in the tribal area.
Vyas.A and
CHETNA,(2009), listening to women’s experience of pregnancy and childbirth,
publication development organization .
The Healing touch, Deepak
Foundation (Annual Reaport-2006-2007)
Prof. Anjali Pahad*, Ms. Nidita Karkare**, Ms.
AvaniPathak ***
*Professor,
**Teaching assistant,*** Research Scholar
Department of
Extension & Communication
Faculty of Family
& Community Sciences,
Maharaja Sayajirao
University,
Vadodara, Gujarat,
India.
